The Pavlik harness was developed in Europe in 1944, and introduced into the United States in 1959. Since then, it has gained in popularity as an effective treatment modality for Congenital Dislocation of the Hip in infants. The Pavlik harness consists of a Chest Halter made up of a belt around the chest, held in place by two shoulder straps, and two foot attachments, each connected to the Chest Halter by an anterior and a posterior leg strap. Traditionally, the buckles for adjustable attachment of the leg straps are on the chest belt. For example, Mubarak in his important paper on the Pavlik Harness published in the Journal of Bone and Joint Surgery (Vol. 63A, No. 8, Oct. 1981) taught that "the buckles for the anterior (flexor) stirrup straps should be located at the child's anterior axilliary line", that is, on the front of the chest. He also taught that "the buckles for the posterior (abduction) stirrup straps should be located over the scapula" or shoulder blade in the back of the chest. With the Chest Halter held securely in place, and adjusting the lengths of the anterior and posterior leg straps, the hip joint can be placed and held in the optimal position for hip stabilisation. This is usually in the position of flexion and abduction. The anterior leg strap limits hip extension and thereby holds the hip in flexion. The posterior leg strap limits hip abduction and thereby holds the hip in abduction. By adjusting the lengths of the anterior and posterior straps, the physician can control the amount of flexion and abduction, holding the hips in optimal position for correction of the hips. The biggest advantage of the Pavlik harness over other forms of splinting is that it allows for controlled motion of the hips during the course of treatment, thus allowing for more normal articular cartilage nutrition and growth.
There are distinct disadvantages however, and they are as follows.
1. The Pavlik harness is notoriously difficult to apply. The Harness as it is presently available consists of a chest halter that has six large metal safety buckles to which the shoulder straps and leg straps are attached. Once the straps are fastened and locked in place, if the position is not optimal, unfastening and refastening is a chore, especially since there are six straps involved (two from the shoulders and four from both legs). A crying wriggingly infant does not make it any easier. Moreover, the shoulder straps and anterior leg straps are applied with the infant supine (on his back) while the posterior leg straps are applied with the infant prone (on his stomach). During adjustment, it is not uncommon to have to flip the crying infant several times to achieve optimal position.
2. The large metal safety buckles on both the front and back of the chest halter makes lying on it very uncomfortable for the infant.
3. Once the harness has been applied, another problem that often arises is the foot escaping from the foot stirrup. Because the heel of the infant is so small, it is easy for the infant to kick the foot forward, slipping away from the stirrup and nullifying the effect of the Pavlik harness. During the course of treatment, the parents have always to be vigilant, making sure that the foot is replaced on the stirrup every time the infants kicks his foot free from the stirrup.
4. Yet another problem that arises during the course of treatment is attachment of the strap to the wrong buckle on the chest halter. Parents after washing the baby at home and replacing the harness not uncommonly attach the strap to the wrong buckles on the chest halter. This not only frustrates treatment, but may also cause damage to the child's hips. One common problem is for the parent to attach the anterior leg strap to the posterior buckle and vice versa, causing the leg to be held in the abnormal internally rotated position (rather than the desired external rotation) potentially harmful to the child's hips.